Healthcare Provider Details

I. General information

NPI: 1164079315
Provider Name (Legal Business Name): JILLIAN LECLAIR WECHE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400A FRANKLIN ST
BRAINTREE MA
02184-5524
US

IV. Provider business mailing address

400A FRANKLIN ST
BRAINTREE MA
02184-5524
US

V. Phone/Fax

Practice location:
  • Phone: 855-732-4842
  • Fax: 781-658-2003
Mailing address:
  • Phone: 855-732-4842
  • Fax: 781-658-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2319977
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: